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the colored is nearly twice that among the white. In such types of external violence as homicides this disparity is marked. In both 1924 and 1925 in Cleveland over 35 per cent of all homicides were among the colored population. In 1925, in a total of 127 homicides in the entire city, 48 were colored.

Fifth, another immediate effect upon the community health of Negro migration refers to the death-rate among infants and maternity cases. During the 5-year period 1910-14, inclusive, there were but 572 births of colored children registered in Cleveland. During the same period there were 918 deaths among the Negroes. The birth-rate was far less than the death-rate. During the 5-year period 1920-24, however, and since migration has occurred, there has been a marked increase in the number of colored births, as might be expected, due to the fact that the migratory group is composed largely of young adults of the wage-earning and child-bearing ages. The total number of colored births in the latter 5-year period was 5,540 as compared with 4,234 colored deaths during the same period. With this increase of births there has been, naturally, an increase of maternal deaths due to puerperal diseases, and also an increase in the deaths of infants under one year of age. The sixty-four deaths due to puerperal diseases for the 5-year period 1920–24 among colored mothers with 5,540 births during the same period indicates a maternal mortality rate in excess of I per 100 births.

Sixth, a remote effect of Negro migration upon the public health lies in the increasing number of deaths, and cases requiring medical relief, caused by the degenerative diseases, such as cerebral hemorrhage, cardiac and circulatory diseases, and nephritis. While in none of these diseases at the present time does the migratory group of Negroes show an increase of mortality rates from those obtaining among the colored group previously, nevertheless the general incidence of such diseases among the entire population, regardless of color, is extremely high, and higher among the colored than among the whites. It must be expected, therefore, that increasing demands will be made upon the relief agencies, both public and private, as a result of the influx of large numbers of a group which, on account of financial restrictions, is unable to provide for itself the necessary relief which these conditions demand.

Finally, as evidenced by mortality statistics, the Negro population, here as elsewhere, has a much higher annual death-rate than the white population. The average annual death-rate among Negroes was 20 per 1,000 in both the 5-year period 1910-14, before migration, and the 5-year period 1920-24, since migration has been going on. During the same period the average annual death-rate among whites fell from 13.5 per 1,000 to 9.6, a decrease of nearly 30 per cent. This decrease has largely been accomplished by the practical application of accepted methods of preventing diseases. While there are many instances where the Negro population has also shown decreased mortality rates in preventable causes of death, there has been a sufficient increase in mortality, due to certain causes, to keep the Negro death-rate stationary. These causes have been largely those

commonly most affecting a group of such age composition as the migratory Negroes have been. Due to the extremely high rate of increase of death due to acute respiratory diseases among the Negroes in 1920-24, there is some reason to believe that the climatic change from the South to the North plays some part in the health problems of the Negro migrants, but overcrowding and poverty are factors as well. The obvious result of Negro migration emphasizes the need for increased efforts on the part of all health agencies to lower the unnecessarily high mortality among the colored population.


Bleecker Marquette, Executive Secretary, Public
Health Federation, Cincinnati

Just as the rapid increase in the number and type of social agencies has given rise to the necessity of councils of social agencies, so too the development of numerous organizations to meet various health problems has given rise to the health council idea in cities. Health councils and federations have been organized so recently, and new ones are being formed so rapidly, that it is difficult to state with accuracy how many there are at the present time. Our best information would indicate that there are the following such organizations in existence, either well organized or in the process of development: Health Council, Cleveland; Health Division, Council of Social Agencies, San Francisco; Health Conservation Association, Kansas City; Tuberculosis and Health Council, Denver; Hennepin County Public Health Association, Minneapolis; Health League, Boston; Health Division of Community Council, St. Louis; Health Council of Community Chest, Louisville; Public Health Association, Toledo; Public Health Federation, Cincinnati.

These councils are organized and operated on plans that differ widely. It is not the purpose of this paper to discuss the different methods of organization and work being pursued by these various federations, but rather to outline briefly the plan of organization of the Cincinnati Federation and some of the things it has been able to accomplish, and then to discuss specific problems involved in the federation of health activities.

Dr. Haven Emerson, after careful studies of the public health resources of several cities, has advocated the federation of health activities as essential to the best results. Dr. Emerson's recommendations led to the organization of the Cleveland Health Council, and later, the Louisville Health Council. The goal of public health work is to foster the best possible facilities for the care of the sick, to reduce preventable disease to the minimum, to promote vigorous, positive health, and to prolong life. It is difficult to accomplish this purpose to the best advantage as long as a variety of specialized health agencies pursue particu

lar phases of public health, concerned only incidentally with the general needs. There is a growing demand in cities for a group whose scope embraces the entire problem, interested in ways and means of meeting new needs as they develop, keeping down the ever increasing cost required by the formation of new agencies, helping organizations to pull together, reducing duplication, working toward united plans and programs. It is this which the health federation or health council endeavors to do.

The Cincinnati Federation.-Organized in 1917 by the late Dr. J. H. Landis, health commissioner, Mr. Courtenay Dinwiddie, then superintendent of the Antituberculosis League, and Mr. C. M. Bookman, director of the community chest, the Cincinnati Public Health Federation is made up of delegates from all private and public health organizations and hospitals and from civic and social agencies especially interested in health. Each organization appoints two delegates to the general body which, in annual meeting, receives reports on the work, makes amendments to the constitution, and elects the officers of the Federation. These officers are president, first vice-president, second vice-president, treasurer, honorary secretary, and twenty members at large.

The work of the Federation is divided among a number of councils, cancer control, child hygiene, housing, mental hygiene, mouth hygiene, nursing, social hygiene, and tuberculosis. The officers, the members at large and the chairmen of each of these divisional councils, which elect their own officers and formulate their own programs, make up the governing body, which we call the coordinating committee. On this committee are the Superintendent of the General Hospital, Dean of the College of Medicine, the City Health Commissioner, and County Health Officer, a special delegate from the Cincinnati Dental Society, and a special delegate from the local graduate nurses' association. It is the health branch of the Community Chest. Its staff consists of an executive secretary and an assistant secretary.

The Cincinnati Federation has been built up on the fundamental thought that there is everything to be gained from the close working together and the dovetailing of the programs of private agencies with government departments. The Federation has on numerous occasions been able to be of service to the city health department, to the county health department, to the General Hospital, and to the College of Medicine. Likewise each one of these official departments has worked in a fine spirit of cooperation with the Federation. In fact it is our agreed policy that tried and proved health activities carried on by private agencies shall be transferred to official departments when these departments are able to finance and conduct them on a reasonably satisfactory basis.

The work of the councils.-Each council is made up of representatives of organizations or of individuals interested in its particular problem. It is possible to mention only in the briefest possible way what the councils have been able to accomplish.

The work of the cancer-control council is entirely educational, its aim being

to keep the public informed of the latest developments in knowledge about cancer, to teach the surpassing importance of consulting a competent physician at the slightest symptoms indicating the possibility of cancer, and to urge annual physical examinations. The council has now under consideration the advisability of establishing a special cancer clinic and ways and means of securing additional facilities for the care of cancer patients.

The chief thing accomplished by the child hygiene council was taking the initiative in a demonstration in the prevention of diphtheria, which was done six years ago, at a time when the Schick test and toxin-antitoxin were not so well understood or so generally used as they are at the present time. There can be no question that the demonstrations conducted at that time by the board of health with the cooperation of the Public Health Federation and the pediatric department of the College of Medicine was responsible in some measure for the acceptance of this procedure by the large group of physicians in the city who are now using it freely. The formulation of health standards for child caring institutions and for children placed in boarding homes was another of this council's activities.

A subdivision of the child hygiene council is the day nursery section. This section, made up of representatives of most of the city's day nurseries, has succeeded in bringing about notable improvements in record forms, in standards of admission, in the education of attendants, and finally, in fostering a high standard of nursing and medical service which is provided in seven of the nurseries by the Babies' Milk Fund Association. Three years ago there were no nurseries in the city for colored children. Today, thanks in part at least to the cooperation of the day nursery section, there are two excellent day nurseries serving colored children.

The mental hygiene council brought about the establishment of a central mental hygiene clinic to serve the courts, the schools, the social agencies, and the general public. The clinic is now one of the community chest organizations filling an important need in the community. Since its organization the clinic has taken care of more than 1,700 patients.

The chief accomplishment of the mouth hygiene council was a study of the problem of dental hygiene in the county and the recommendation of a program which resulted in the county health department establishing dental service in the county schools. Before that time there had been no work along this line in the county. Last year the teeth of practically every child in the county schools were examined.

The nursing council has selected as its principal objective the recruiting of trainees for the nursing profession. An effective campaign has been carried out during the past two years, which, it is hoped, will have the effect of stimulating greater interest in the nursing profession and attracting additional recruits.

The Executive Secretary of the Public Health Federation is director of the Better Housing League, a member of the board of directors of the Anti-tubercu

losis League, of the Social Hygiene Society, and of the Public Dental Service Committee, thus keeping the Federation in close touch with the activities of these organizations.

Major activities of the Federation. The major pieces of work accomplished by the Public Health Federation have perhaps been done independently of the councils.

In 1921 the Federation conducted a most successful health exposition, participated in by practically every public and private health agency in the city, as well as by many national agencies. Organized and promoted wholly by Cincinnati health organizations, with the complete cooperation of civic groups and public departments, with an excellent program of lectures by national health authorities and an attractive program of pageants, spectacles, and motion pictures, the exposition drew an attendance of 150,000 people. On next to the last night of the exposition hundreds were turned away. It had a beneficial effect in promoting interest in public health and did much to establish the Federation in the confidence of the public.

The Federation was largely responsible for organizing a public campaign to relieve the outrageous condition of overcrowding at Longview, Hamilton County's hospital for the insane. For a period of nearly ten years an average of two hundred patients had been forced to sleep upon the floors. This effort, vigorously backed by civic organizations, brought relief. Today there is not a single patient sleeping on the floor of Longview. The Longview buildings will be purchased by the state, probably before the end of this year, as a result of the agitation started by the Federation.

The appropriations by the Ohio legislature for the ultimate construction of two new institutions for the feebleminded had its origin in a bill introduced through the efforts of the Public Health Federation. We supported the Ohio Institute in the campaign which induced the legislature to vote the necessary funds.

The Federation was able to secure an enabling act through the state, a city ordinance, and an appropriation of the board of education which resulted, last October, in the transfer of our farm for problem boys to the board of education. This institution is now in the course of radical reorganization under the direction of an able superintendent. It is expected that the transfer of our Girl's Opportunity Farm will follow shortly.

Through the president of the Federation the cardiac clinic was launched. This clinic, begun in a modest way with practically no funds, is now a part of the department of medicine of the General Hospital. It marks the beginning of a much-needed program in our city for the prevention and relief of heart disease.

The Federation loaned the services of its educational director last year in the making of a thorough and valuable study of hospital facilities and hospital needs of our city. The survey was made under the auspices of the Trounstine Foundation, Cincinnati's research bureau. It has furnished pertinent facts on

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